1.
Carolyn, Great discussion post! Very informative. Great explanation of diverticulitis and diverticulosis and reasonings for antibiotics and iv fluids. I think so necessary to admit a patient like this because the risk of developing abscess or possible perforation of the bowel. Although the risk is low, the patient is high risk due to age. while reading your post it may be want to do research more in detail research regarding surgery related cases. I found this and thought is was so interesting." The most well-known classification system for diverticulitis is the Hinchey classification, described in 1978 based on operative findings at the time of surgery. Hinchey stage 1 is considered “uncomplicated” diverticulitis, and is defined by diverticulitis with a pericolic phlegmon or a small pericolic (<2 cm) abscess. Hinchey stage 2 falls under the category of “complicated” disease and is defined as diverticulitis with a pelvic, abdominal, or retroperitoneal abscess. Hinchey stage 1 and 2 are contained perforations, usually caused by a micro perforation. Hinchey stage 3 is defined as diverticulitis with generalized purulent peritonitis, while Hinchey stage 4 is diverticulitis with generalized feculent peritonitis. Hinchey stage 3 and 4 are free perforations. These occur in less than 10% of patients who present with diverticulitis. Hinchey stages correlate with mortality (<5% for stage 1-2, 13% for stage 3, 43% for stage 4) " (Khalil et al., 2014). I had no idea about this staging. Pretty interesting in my opinion.
Courtney
Khalil, H. A., & Yoo, J. (2014, April 18). Colorectal emergencies: Perforated diverticulitis (operative and nonoperative management). Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961523/
2.
Hi Susan,
Great post! Your mention of the prevalence of diverticulitis in the left side of the colon reminded me that I read in our textbook that people in Western countries tend to have more left colon diverticula and people in Asian countries tend to have more right-sided diverticula (McCance et al., 2019). I found this fact interesting and decided to do some further investigating.
In a study conducted by Lee et al. (2020), right-sided diverticulitis is rare in Western countries and left-sided diverticulitis is rare in Asian countries. Right-sided diverticula are more likely to be false diverticula. False diverticula do not include the muscle hypertrophy of the gastrointestinal tract. Additionally, right-sided diverticulitis develops more frequently in younger patients and is less likely to lead to hospitalization. Left-sided diverticulitis is more likely to reoccur in patients. Also, it was found that patients who smoked and had longer hospital stays were more likely to have a reoccurrence.
Generally, it appears that right-sided diverticulitis is more likely to be congenital in nature than it's left-sided counterpart.
Thanks,
Carolyn
References
Lee, K., Lee, J., Park, Y.Y., Kim, Y., & O, S.T., (2020). Difference in clinical features between right- and left-sided acute colonic diverticulitis. Scientific Reports, 10(3754). https://doi.org/10.1038/s41598-020-60397-5
McCance, K.L., Huether, S.E., Brashers, V.L., & Rote, N.S. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.